230 results found
Granados A, Low-Beer N, Higham J, et al., 2018, Real-time Visualisation and Analysis of Clinicians' Performance during Palpation in Physical Examinations, IEEE Transactions on Biomedical Engineering, ISSN: 0018-9294
CCBY Objective: Motivated by the fact that palpation skills are challenging to learn and teach, particularly during Digital Rectal Examinations (DRE), and the lack of understanding of what constitutes adequate performance, we present a visualisation and analysis system that uses small position and pressure sensors located on the examining finger, allowing the quantitative analysis of duration, steps and pressure applied. Methods: The system is first described, followed by an experimental study of twenty experts from four clinical specialties performing ten DREs each on a benchtop model using the proposed system. Analysis of the constitutive steps was conducted to improve understanding of the examination. A Markov model representing executed tasks and analysis of pressure applied is also introduced. Results: The proposed system successfully allowed the visualisation and analysis during the experimental study. General Practitioners and Nurses were found to execute more tasks compared to Urologists and Colorectal Surgeons. Urologists executed the least number of tasks and were the most consistent group compared to others. Conclusion: The ability to "see through" allowed us to better characterise the performance of experts when conducting a DRE on a benchtop model, comparing the performance of relevant specialties, and studying executed tasks and the pressure applied. The Markov model presented summarises task execution of experts and could be used to compare performance of novices against that of experts. Significance: This approach allows for the analysis of performance based on continuous sensor data recording that can be easily extended to real subjects and other types of physical examinations.
Kneebone R, 2018, The art of conversation, Lancet, Vol: 391, Pages: 731-731, ISSN: 0140-6736
Kneebone R, 2018, Getting back in touch., Lancet, Vol: 391, Pages: 1348-1348, ISSN: 0140-6736
Kneebone R, 2018, Improvising medicine, LANCET, Vol: 391, Pages: 2097-2097, ISSN: 0140-6736
Kneebone RL, 2018, Introducing In Practice, LANCET, Vol: 391, Pages: 723-723, ISSN: 0140-6736
Palfreyman H, Kneebone RL, 2018, Blind alleys and dead ends: researching innovation in late 20th century surgery., Med Humanit
This article examines the fortunes of one particular surgical innovation in the treatment of gallstones in the late 20th century; the percutaneous cholecystolithotomy (PCCL). This was an experimental procedure which was trialled and developed in the early days of minimally invasive surgery and one which fairly rapidly fell out of favour. Using diverse research methods from textual analysis to oral history to re-enactment, the authors explore the rise and fall of the PCCL demonstrating that such apparent failures are as crucial a part of innovation histories as the triumphs and have much light to shed on the development of surgery more generally.
Weldon SM, Kelay T, Ako E, et al., 2018, Sequential simulation used as a novel educational tool aimed at healthcare managers: a patient-centred approach, BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING, Vol: 4, Pages: 13-18, ISSN: 2056-6697
Weldon SM, Kronfli M, Bello F, et al., 2018, Using a Variety of Research Methods and Angles to Understand a New Approach That Explores Health-Care Services, Publisher: SAGE PUBLICATIONS INC, Pages: 57-57, ISSN: 1609-4069
Bezemer J, Cope A, Korkiakangas T, et al., 2017, Microanalysis of video from the operating room: an underused approach to patient safety research, BMJ QUALITY & SAFETY, Vol: 26, Pages: 583-587, ISSN: 2044-5415
Cope A, Bezemer J, Mavroveli S, et al., 2017, What Attitudes and Values Are Incorporated Into Self as Part of Professional Identity Construction When Becoming a Surgeon?, ACADEMIC MEDICINE, Vol: 92, Pages: 544-549, ISSN: 1040-2446
Frampton S, Kneebone RL, 2017, John Wickham's New Surgery: 'Minimally Invasive Therapy', Innovation, and Approaches to Medical Practice in Twentieth-century Britain, SOCIAL HISTORY OF MEDICINE, Vol: 30, Pages: 544-566, ISSN: 0951-631X
Kelay T, Chan KL, Ako E, et al., 2017, Distributed Simulation as a modelling tool for the development of a simulation-based training programme for cardiovascular specialties., Adv Simul (Lond), Vol: 2, ISSN: 2059-0628
Aims and background: Distributed Simulation is the concept of portable, high-fidelity immersive simulation. Here, it is used for the development of a simulation-based training programme for cardiovascular specialities. We present an evidence base for how accessible, portable and self-contained simulated environments can be effectively utilised for the modelling, development and testing of a complex training framework and assessment methodology. Iterative user feedback through mixed-methods evaluation techniques resulted in the implementation of the training programme. Approach: Four phases were involved in the development of our immersive simulation-based training programme: (1) initial conceptual stage for mapping structural criteria and parameters of the simulation training framework and scenario development (n = 16), (2) training facility design using Distributed Simulation, (3) test cases with clinicians (n = 8) and collaborative design, where evaluation and user feedback involved a mixed-methods approach featuring (a) quantitative surveys to evaluate the realism and perceived educational relevance of the simulation format and framework for training and (b) qualitative semi-structured interviews to capture detailed feedback including changes and scope for development. Refinements were made iteratively to the simulation framework based on user feedback, resulting in (4) transition towards implementation of the simulation training framework, involving consistent quantitative evaluation techniques for clinicians (n = 62). For comparative purposes, clinicians' initial quantitative mean evaluation scores for realism of the simulation training framework, realism of the training facility and relevance for training (n = 8) are presented longitudinally, alongside feedback throughout the development stages from concept to delivery, including the implementation stage (n = 62). Findings: Initially, mean evaluation scores flu
Kneebone R, 2017, Medicine: Discovery through doing., Nature, Vol: 542
Kneebone RL, 2017, Making medicine bespoke, LANCET, Vol: 389, Pages: 19-19, ISSN: 0140-6736
Kneebone RL, 2017, Bespoke practice, LANCET, Vol: 389, Pages: 28-29, ISSN: 0140-6736
Kneebone RL, 2017, The art of medicine Performing magic, performing medicine, LANCET, Vol: 389, Pages: 148-149, ISSN: 0140-6736
Kneebone RL, 2017, The individual and the system, LANCET, Vol: 389, Pages: 360-361, ISSN: 0140-6736
Kneebone RL, 2017, The art of medicine Materiality and thread, LANCET, Vol: 389, Pages: 246-247, ISSN: 0140-6736
Kneebone RL, Nestel D, Bello F, 2017, Learning in a simulated environment, A Practical Guide for Medical Teachers, Editors: Dent, Harden, Hunt, Hodges, Publisher: Elsevier, Pages: 92-100, ISBN: 9780702068911
This highly regarded book recognises the importance of educational skills in the delivery of quality teaching in medicine. The contents offer valuable insights into all important aspects of medical education today.
Sadideen H, Goutos I, Kneebone R, 2017, Burns education: The emerging role of simulation for training healthcare professionals, BURNS, Vol: 43, Pages: 34-40, ISSN: 0305-4179
Bezemer J, Korkiakangas T, Weldon S-M, et al., 2016, Unsettled teamwork: communication and learning in the operating theatres of an urban hospital, JOURNAL OF ADVANCED NURSING, Vol: 72, Pages: 361-372, ISSN: 0309-2402
Bezemer J, Murtagh G, Cope A, et al., 2016, Surgical decision making in a teaching hospital: a linguistic analysis, ANZ JOURNAL OF SURGERY, Vol: 86, Pages: 751-755, ISSN: 1445-1433
Huddy JR, Weldon S-M, Ralhan S, et al., 2016, Sequential simulation (SqS) of clinical pathways: a tool for public and patient engagement in point-of-care diagnostics, BMJ OPEN, Vol: 6, ISSN: 2044-6055
Kneebone R, 2016, Prosthetic possibilities, The Lancet, Vol: 388, Pages: 1045-1046, ISSN: 0140-6736
Kneebone R, 2016, Modelling the body, The Lancet, Vol: 387, Pages: 114-115, ISSN: 0140-6736
Kneebone R, Weldon S-M, Bello F, 2016, Engaging patients and clinicians through simulation: rebalancing the dynamics of care., Adv Simul (Lond), Vol: 1, ISSN: 2059-0628
This paper proposes simulation-based enactment of care as an innovative and fruitful means of engaging patients and clinicians to create collaborative solutions to healthcare issues. This use of simulation is a radical departure from traditional transmission models of education and training. Instead, we frame simulation as co-development, through which professionals, patients and publics share their equally (though differently) expert perspectives. The paper argues that a process of participatory design can bring about new insights and that simulation offers understandings that cannot easily be expressed in words. Drawing on more than a decade of our group's research on simulation and engagement, the paper summarises findings from studies relating to clinician-patient collaboration and proposes a novel approach to address the current need. The paper outlines a mechanism whereby pathways of care are jointly created, shaped, tested and refined by professionals, patients, carers and others who are affected and concerned by clinical care.
Kneebone RL, 2016, Performing surgery, Performance and the Medical Body, Publisher: Bloomsbury Publishing, Pages: 67-81, ISBN: 9781472570802
This edited collection focuses on performance practice and analysis that engages with medical and biomedical sciences.
Kneebone RL, 2016, Performing Surgery: Commonalities with Performers Outside Medicine, FRONTIERS IN PSYCHOLOGY, Vol: 7, ISSN: 1664-1078
Kneebone RL, 2016, Simulation reframed., Adv Simul (Lond), Vol: 1, ISSN: 2059-0628
Background: Simulation is firmly established as a mainstay of clinical education, and extensive research has demonstrated its value. Current practice uses inanimate simulators (with a range of complexity, sophistication and cost) to address the patient 'as body' and trained actors or lay people (Simulated Patients) to address the patient 'as person'. These approaches are often separate.Healthcare simulation to date has been largely for the training and assessment of clinical 'insiders', simulating current practices. A close coupling with the clinical world restricts access to the facilities and practices of simulation, often excluding patients, families and publics. Yet such perspectives are an essential component of clinical practice. Main body: This paper argues that simulation offers opportunities to move outside a clinical 'insider' frame and create connections with other individuals and groups. Simulation becomes a bridge between experts whose worlds do not usually intersect, inviting an exchange of insights around embodied practices-the 'doing' of medicine-without jeopardising the safety of actual patients.Healthcare practice and education take place within a clinical frame that often conceals parallels with other domains of expert practice. Valuable insights emerge by viewing clinical practice not only as the application of medical science but also as performance and craftsmanship.Such connections require a redefinition of simulation. Its essence is not expensive elaborate facilities. Developments such as hybrid, distributed and sequential simulation offer examples of how simulation can combine 'patient as body' with 'patient as person' at relatively low cost, democratising simulation and exerting traction beyond the clinical sphere.The essence of simulation is a purposeful design, based on an active process of selection from an originary world, abstraction of what is criterial and re-presentation in another setting for a particular purpose or audience. This
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